David Freiburger said his girlfriend Laura Mellen woke him up early on a Sunday morning about three weeks ago to tell him that her elbow hurt.

”It wasn’t much of a concern,” Freiburger, 37, said. ”She took some ibuprofen and went back to bed.”

The couple had spent the weekend moving Mellen, 32, and her two children into Freiburger’s home in Bend, and Freiburger said Mellen supposed her elbow was sore from all the unpacking.

That same weekend Freiburger had told Mellen’s father that he planned to propose.

”For a while, she’s been the only one who didn’t know,” Freiburger, who works for BendCable, said Tuesday.

That’s because the soreness in Mellen’s arm had led to more than three weeks in St. Charles Medical Center and a fight for Mellen’s life against a severe flesh-eating bacterial infection.

By Sunday, June 15, the morning of the weekend she and her children moved in with Freiburger, the pain in her elbow had worsened enough to send Freiburger and Mellen to the emergency room at St. Charles.

”They thought she had tendonitis,” Freiburger said.

Mellen went home with a prescription for Vicodin, a pain medication, and a sling for her arm.

A little more than 24 hours later, Freiburger and Mellen were back in the emergency room. Mellen was unable to walk on her own. Her right arm was swollen from her fingertips to her shoulder and her blood pressure was dropping dramatically.

In the next three days, she would be pumped with antibiotics, experience kidney failure and be connected to a ventilator to breathe. She would also have her right arm amputated from just above the elbow.

The cause of Mellen’s problem was a massive bacterial infection called necrotizing fasciitis, also known as ”flesh-eating bacteria.” The infection damages and destroys the fascia, the membrane covering, supporting and separating muscles.

Dr. Richard Fawcett, an infectious diseases specialist at Bend Memorial Clinic, said necrotizing fasciitis is caused by bacteria, usually the Group A Streptococcal bacteria, which also causes strep throat. Fawcett was a member of the medical team that treated Mellen.

”Skin infections, not as severe as the necrotizing fasciitis – those infections such as cellulitis – are usually caused by the same bacteria,” he said. Cellulitis is also a skin infection.

To develop into an infection, the bacteria needs a way to get into the skin, such as a cut or bruise, something that Fawcett calls a ”portal of entry.” And once the bacteria gets into the skin and deeper layers, such as the fascia, it can quickly damage and destroy the tissue, he said.

But how did Mellen contract the bacteria in the first place?

Fawcett said it’s hard to know.

”The bacteria came from her skin, most likely, and not an animal,” he said. ”It’s a natural bacteria, we carry it naturally.”

In Mellen’s case, the bacteria may have entered her skin through a scratch on her forearm, which family members say she received from a cat. She works as an assistant at Blue Sky Veterinary Clinic.

Fawcett said it’s not possible to confirm how the bacteria got into Mellen’s body.

Donna Batdorff, co-founder of the National Necrotizing Fasciitis Foundation, said she’s heard from people around the nation who say the bacteria entered the skin through a small puncture caused by a staple or a bruise from bumping too hard against a file cabinet.

The foundation’s purpose is to educate people about necrotizing fasciitis and support those who survive it.

Batdorff lived through the ”flesh-eating bacteria” in 1996. She lost portions of three fingers on her right hand and said her right arm is severely scarred.

Fawcett said people with other skin conditions, such as chicken pox or shingles, as well as those whose immune systems may not be as strong, such as those with diabetes, may be more susceptible to the infections. However, he added, it can happen to otherwise healthy people, such as Mellen.

Rick McKenzie, Mellen’s father, said his daughter is an active mom, who focuses much of her time on her 7-year-old daughter, Bryanna, and 10-year-old son, Jordan.

Mellen’s father, her mother Carol McKenzie, and Freiburger made sure one or all of them have been at Mellen’s side since she entered St. Charles on June 16.

”She does all sorts of things, she water skis,” her father said. ”And I expect to see her doing this again.”

Not all of those with invasive skin infections need surgery or have to have limbs amputated, Fawcett said. Doctors may also fight the bacteria with intravenous antibiotics when the infection is caught early.

”Amputation is the last resort,” he said. ”And the reason that it often happens is that muscle is infected.”

With Mellen, her infection progressed very rapidly, he said, and when she was first seen in the emergency room there was no sign of skin infection. Most with bacterial skin infections usually have a visible rash, he said.

According to numbers available from the Centers for Disease Control and Prevention (CDC), about 9,400 cases of invasive GAS disease occurred in the United States in 1999, the only figures available. Of those, about 600 were necrotizing fasciitis.

In contrast, the CDC Web site reported that there are several million cases of strep throat and impetigo, another type of skin disease, a year.

Fawcett estimated that he sees about eight or nine cases of severe, invasive, bacterial skin infections in a year. Mellen’s, he said, is the most severe he’s seen in a long time.

To prevent such infections, the CDC recommends that people wash their hands frequently, keep all skin wounds clean and be on the lookout for skin infections that become red, swollen and are severely painful. Having a fever is another symptom.

”The key is to make sure that simple skin infections don’t turn very painful,” Fawcett said.

Mellen has spent the last three weeks in the Critical Care Unit at St. Charles Medical Center recovering from the infection and related complications, such as damage to her lungs. She moved out of critical care Monday, but not before Freiburger popped the question.

Mellen accepted. ”I got down on one knee in the CCU,” he said.

The couple met almost two years ago at their daughters’ day care center. Mellen’s daughter and Freiburger’s daughter both recently finished the first grade. Mellen’s parents say her spirits have been up and, as of Monday, she no longer needs to be hooked up to a ventilator to breathe.

”She is happy to be alive,” Carol McKenzie said. ”And she’s anxious to see her children.”

The family has set up a fund at the Bank of the Cascades to help Freiburger and Mellen pay for medical expenses, a prosthetic arm, outfitting their home for Mellen’s return and counseling for her children. She has medical insurance, but the family is not sure what costs will be covered.

”We are usually really quiet people,” Freiburger said. ”But I also realize we might need some help.”

Those wanting to make a donation, may donate to the Laura Mellen account at any branch of the Bank of the Cascades.

Kelly Kearsley can be reached at 541-383-0348 or at kkearsley@bendbulletin.com.